Stronger community ties linked to lower risk of multiple long-term conditions in Scotland, study finds

People living in areas with lower levels of “social gifting” - the willingness of residents to give their time to support others in their community - are more likely to develop multiple long-term conditions, a new study led by Dr Chunyu Zheng in the School of GeoSciences has found.

The study, funded by the NIHR, forms part of the AIM-CISC (Artificial Intelligence and Multimorbidity – Clustering in Individuals, Space and Clinical) programme. It brings together a multidisciplinary team of clinicians and researchers from public health, AI, geography and social policy across the University of Edinburgh – including the Usher Institute, School of Informatics, School of GeoSciences, and the School of Social and Political Science – to explore how community environments shape health.

Two people walking along shoreline in a city

The research is the first to examine how this aspect of the local social environment is linked to multimorbidity - the co-existence of two or more long-term conditions - at a national scale.

Growing global challenge

The number of people living with multiple long-term conditions (MLTC) is rising worldwide, posing a major public health challenge. MLTC are associated with reduced quality of life, increased reliance on health and social care services, and significantly higher healthcare costs.

They are also shaped by inequality. People living in the most disadvantaged areas tend to develop multiple conditions 10 to 15 years earlier than those in more affluent communities, and these gaps are continuing to widen.

What is social gifting?

Social gifting refers to the collective willingness within a neighbourhood for people to give their time to others - for example through informal support, volunteering, or helping neighbours. It reflects levels of trust, reciprocity and social connection within communities.

Researchers investigated whether this community-level characteristic influences the likelihood of developing multiple long-term conditions.

National-scale analysis

The study analysed data from the Scottish Longitudinal Study (SLS), focusing on people aged 40 to 75 who took part in the 2011 Census and had no record of multiple long-term conditions before 2010.

Findings show that people living in areas with lower levels of social gifting were more likely to go on to develop MLTC across most measures.

The strongest association was found for “mental-physical” MLTC, where individuals experience both mental and physical health conditions. One possible explanation is that social connections and community support may have a more direct influence on mental health, which in turn affects physical health outcomes.

Urban–rural differences

The study also found that the relationship between social gifting and health varied depending on where people lived.

In urban areas, lower levels of social gifting were strongly associated with a higher likelihood of developing multiple long-term conditions, particularly those involving both mental and physical health.

In contrast, small towns and rural areas – which tended to have higher levels of social gifting and lower overall rates of MLTC – showed a weaker relationship, with some evidence that the pattern differs from that seen in urban areas, which is possibly because the small towns and rural areas don’t sufficiently cross into the ‘low social gifting’ before an association is observed.

The findings suggest that stronger community ties in urban areas may help protect against the development of multiple conditions.

Neighbourhoods with higher levels of social gifting may also benefit from greater social trust, stronger relationships, and lower levels of exclusion. These factors can support better mental wellbeing, which may also reduce the risk of developing physical health problems.

Implications for policy

The findings highlight the importance of local social environments in shaping the health outcomes of communities and point to potential policy interventions.

Cuts to local government spending, which can reduce access to community spaces, services and opportunities for social participation, may have unintended consequences for public health.

Conversely, investment in local services and community infrastructure could help strengthen social connections, reduce health inequalities, and slow the growing burden of multiple long-term conditions, particularly in urban areas.

The study provides strong evidence that social gifting - a key but often overlooked feature of community life - plays a meaningful role in shaping health across Scotland.

To our knowledge, this is the first study that explores the links between neighbourhood social gifting and MLTC and how this link may vary across urban-rural settings at the national scale by using large-scale data linkage across multiple databases.
Our findings highlight the important role of social gifting in protecting individuals against MLTC, particularly for mental-physical MLTC in urban areas of Scotland and calls attention to initiatives at the local level, which may have the potential to reduce MLTC risks, support healthy ageing, and reduce health inequalities by encouraging voluntary social participation and strengthening social ties.

Growing global challenge

What is social gifting?

National-scale analysis

Urban–rural differences

Implications for policy

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